Artikel 53 – Application In The Field DHF Based on Pathogenesis And Patophysiology of Halstead’s Theory (A Case Discussion)

Application In The Field, DHF Based on Pathogenesis And Patophysiology of Halstead’s Theory

(A Case Discussion)

It is often to be found in hospitals, a doctor gives therapy to DHF patients which if we take a look closely is not actually based on pathogenesis and pathophysiology of Dengue virus infection of Halstead’s theory. We realize that it’s not the cure that will make someone be called as a doctor. Jesus, Rasputin, prophet Muhammad, and other figures can cure the disease. But they are not being called as a doctor. They might get titles such as saints, shamans, mystics, etc. The doctor title can only be given after they cure people based on pathogenesis or pathophysiology or mechanism of the disease or what are the organs that might be hampered by the disease. Because of that it will be very intriguing if a doctor criticizes DHF treatments that are not based in pathogenesis and pathophysiology of the disease. And for DHF pathogenesis and pathophysiology that is acknowledged by WHO is based on Halstead’s theory.

Here I write to you that doctor’s article and my answer for him


This might be a pretty ridiculous writing
How can it be possible, a doctor really asks patients to be careful of doctor services.

But this is the advice given by doctor Billy as written in the “Konsul Sehat ” (
Konsul Sehat is a site for advancing public education especially in the health sector.

As told by Dr. Billy in the article, for several days Dr. Billy was taking care of his older brother who is suffering from dengue hemorrhagic fever (DHF).
This doctor made a cover letter to be hospitalized in one of the PRIVATE HOSPITAL which was known to be quite good at its service.

Since entering the emergency room, Billy accompanied him to enter the treatment room and waited for his older brother everyday.
So he was very aware of the development of his older brother’s condition.

“I forced my older brother to stay in hospital because his platelets were 82000.
A bit worried, “he said.
Even though the older brother refused because he felt he was healthy, had no fever, was not nauseous, he just felt that his body was a little weak.

Starting at ER, Billy already felt something was ‘suspicious’.
Because Billy did not state that he was a doctor to the hospital staffs, so he could hear various information / explanations and questions from doctors and nurses which he thought were ‘ridiculous’.

The patient was re-examined for blood.
This is still acceptable.
The platelet yield remains the same, 82000.

When the older brother would undergo ECG test, the older brother has started to ‘make a fuss’ because last December he has been on the ECG tested on a treadmill and the results were very good.
Then Billy calm down his older brother by telling him  it was just the procedure at the hospital.

But what made Billy so curious was that the older brother had to be injected with Ranitidine (a medicine for stomach disease), even though his stomach was fine, and didn’t complain of any pain at all.
This drug was injected when Billy was delivering blood samples to the lab.

The doctor gave prescriptions to buy, prescribed for three days, even though tomorrow the internist will visit him, and usually the medicine will change again.
Not to mention the recipe was not appropriate for DHF. So recipes weren’t bought at all.
Billy asked to his friend who practiced at the hospital about the internist doctor , he said he is highly recomended , because he is ‘good and smart’, plus he worked exclusively at the hospital, so he will be always on standby from the sun rise until sun set.

Later that night, via telephone, the internist doctor gave instructions to check with various labs.
After Billy saw the results, many were ‘not connected’, so Billy asked his older brother to only agree to some which were still rational.

The next day, Billy came to the hospital late in the afternoon.
The internal medicine doctor has visited and did not comment on the lab examination that was rejected.
Billy was asked by the nurse to redeem the prescription to the pharmacy.
When Billy saw the recipe, he was surprised.
In the recipe written for injecting Ondansetron, an anti-nausea / vomiting drug for people who have cancer and undergo chemotherapy.
Even though his older brother is not nauseous at all, especially vomiting.
Ranitidin syringes are also written, which are not needed because the older brother does not have stomach pain.
Moreover branded paracetamol was being prescribed again, even though older Brother had said that he has a lot of it.

Because Billy felt so confused, He checked on the internet. Is there a new protocol for handling dengue that he missed or new uses from Ondansetron.
But apparently not.
Finally Billy only bought vitamin supplements from the recipe.

When Billy handed the medicine to the nurse, the nurse asked where is the injection drug?
Billy replied that the patient did not agree to being given the drug.
The nurse put anger on her face.
Finally Billy forced to say that his profession is a doctor, and he is the one who was referring that patient to the hospital.
“My older brother refused the drugs after asking me”.
In fact, I was called to the nurse station and asked to sign a refusal consent letter by the head of the nurse, said Billy.

“I just let you know that the patient is 100% aware, so the patient must be the one to sign, and the doctor must explain about the procedure directly.
Meanwhile the visiting doctor did not explain anything about the drugs he gave.
I left the head nurse who was ‘stunned’, “he said.

When Billy was waiting for his older brother, the patient in the bed next to him is also suffering from dengue fever, and he has been prescribed 5 bottles of expensive antibiotic infusion and  2 bottles were already used up, even though the physical condition and results of his lab have nothing to do with bacterial infection.
This patient is treated by another internist doctor.
When the patient’s internist was visiting the patient, he only said ‘sick?’, ‘Still feeling hot?’
Visite didn’t even take up to three minutes.

The next day the internist doctor who handled his older brother visite again and said nothing about the refusal to buy the medicine he prescribed.
He just said that if the platelets had gone up then he could go home.

“I imagined, I was not surprised at all that PONARI and others were sell well , because even the doctors treatments themselves were not rational after all.”

Sad, many patients are forced to be poisoned by drugs that are not needed, and ‘made poor’ to buy expensive drugs. This is not yet include the cost of a specialist doctor who has to be ‘paid’  quite expensive who in the end did not even give much explanation to patients, while sometimes families deliberately gather & amp; waiting for hours just to wait for the doctor to visit. “said doctor Billy.

Previously Billy had also been waiting for another older brother who was hospitalized at one of the best private hospitals in one of the small towns in Central Java due to typhoid disease.

“If this is not immediately resolved, I cannot blame the community if they prefer alternative medicine or seek treatment overseas.
Hopefully this info can be useful as a valuable lesson for all readers to be careful and critical of doctor’s treatment, “Billy wrote, closing his article.

Our question now is, should all of our patients be accompanied by their relatives who is a doctor on his own so that they don’t get careless treatment?

Your best friend, Dr. Billy Nugraha … Share and make this viral

I will respond to the writing of Dr. Billy. The writing of Dr. Billy is believed to be true by almost all general practitioners and even the majority of internist specialists. Because that’s what medical faculty teaches. Treatment of dengue infection based on the pathogenesis and pathophysiology of Halstead is generally only given fluid therapy. And dengue infection will usually heal itself (self-limited diseases). This is evidenced by reports of deaths of less than 1% in all dengue hyper endemic regions such as Indonesia, Thailand, Singapore, Malaysia, Myanmar, Brunei Darussalam, Vietnam and the Philippines. Even Brunei Darussalam has reported 0% DHF deaths (based on 2015 data). Where according to the WHO report, Southeast Asian countries are accounted for +/- 70% of DHF worldwide. Because it is self-limited disease, it is understandable that Dr. Billy refused to carry out the examination of the heart record. Because before the dengue illness came, there had been a heart record and even a treadmill test with good results. Based on dengue infection criteria as self-limited disease, Dr. Billy’s rejection for his older brother to be given ranitidine, ondansentron and non-generic paracetamol can also be accepted. Likewise, if Dr. Billy refused blood tests other than peripheral blood (hemoglobin, leukocytes, platelets).
Saying DHF is actually self-limited disease is wrong. Because it is based only in patients who are being hospitalized. Even though according to WHO at least 2% of Indonesian people suffer from dengue disease (5,200,000 people). And WHO estimates that DHF patients treated in all hospitals in Indonesia estimate only 2% (104,000 people) from total of Indonesian people that are affected by the DHF (5.200.000 people). The WHO estimation turned out to be less suitable with the 2015 Indonesian Ministry of Health report. The Ministry of Health Republic of Indonesia reported only 126,675 people with DHF in 34 provinces in Indonesia. There was no doubt that the data was obtained from reports of hospitalized patients.
As said above, according to WHO, Dengue sufferers in Indonesia are at least 5,200,000 people. So what happens to untreated dengue sufferers (5,096,000 people), their fate is remain unknown. Are they cured or dead. There is no data for that. Or as a percentage 98% of DHF patients have unknown fate. Thus saying DHF is a disease that has to be categorized in self-limited diseases based solely on patients who are hospitalized is absurd. And it is more absurd to say that dengue deaths in Indonesia is only <1%. Because the report is based solely from patients who are treated in hospitals. Patients in the hospital have gotten adequate fluid therapy and rest. While 98% of DHF patients who were not treated were not receiving adequate fluid therapy or adequate rest. With these data, it can be ascertained that DHF deaths in Indonesia are> 1% of actual DHF sufferers in Indonesia.
After we reject that DHF patients are self limited diseases, then it is only common thing, if the patient enters the emergency room with severe clinical symptoms due to Dengue for example damage to the heart, liver, kidneys and so on. And such severe symptoms are not directly proportional to platelet count in these patients. Platelet count may have risen to near 100000 / mm3 or more. But damage to the heart, kidneys, liver and other organs may still be ongoing. Adrian, Ratana, Waly, have reported the presence of myocarditis in DHF patients as written in the European heart journal Supplement (2017) 19 (Supplement E), E53-E 73. Writings about the relationship between myocarditis and dengue infection can be easily found on Google. The attacks of severe Dengue infection which simultaneously attacks important organs such as the heart, liver and kidneys, have also been reported by Waly, Bandiara (kidney expert), Pohan (tropical disease expert), Riyanto (tropical disease expert). (Kidney, heart, and liver function disorders due to complications of Dengue infection in patients who conducted heparinization and haemodialysis) Based on these reasons, doing heart record in DHF patients, especially patients who are quite old, like Billy’s older brother, is something that is relevant. Giving ranitidine is also a natural thing too. Because gastric deterioration in DHF patients can occur very quickly. A deterioration that might cause erosion or serious injury to the stomach. Or the administration of drugs that reduce gastric acid secretion is a matter of relevance no matter how patients are not complaining of stomach pain or nausea. Likewise on the matter of administering ondansentron or anti-nausea drugs. Ondansentron is not only given to cancer patients, as said by Billy. Although giving paracetamol from a patent drug depends on the doctor’s beliefs. Many doctors believe that patent medicine is better than generic drugs.

The conclusion in the article above is that clinical symptoms in DHF patients cannot be predicted. Because of that laboratory examination other than hemoglobin, leukocytes or platelets tests are needed, liver, kidney and electrolyte function tests can be accepted. Last input for  Dr. Billy is that the pathogenesis and pathophysiology of DHF according to WHO is still controversial. Therefore, it is OK for a doctor not to use the pathophysiology and pathogenesis of DHF as stated by Halstead. For example, he might use pathogenesis and pathophysiology as suggested by Waly “Again, Lets discuss DHF Pathogenesis and Pathophysiology (revision)” or other writings entitled “We can’t refute that the pathogenesis and pathophysiology of Dengue infection is hypersensitivity type III” or another writing titled “Benefits of diagnosing Dengue virus infection based on WHO 2009 and T.MUDWAL’s theory.” Everything can be read on the site Whereas according to T.MUDWAL the pathogenesis and pathophysiology of dengue infection are type III hypersensitivity reactions or immune complex reactions. Based on that basis, to prevent a severe attack of dengue infection, high doses of corticosteroids are absolutely necessary to be given before the 5th day of illness. It is hoped that Dr. Billy may not be surprised later if he found that there are doctors who give high-dose corticosteroids in the case of dengue infection.
Hope it is useful.

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